Low socioeconomic status is a poor prognostic factor for survival in stage I nonsmall cell lung cancer and is independent of surgical treatment, race, and marital status

Authors

  • S.-H. Ignatius Ou MD, PhD,

    Corresponding author
    1. Chao Family Comprehensive Cancer Center, Division of Hematology/Oncology, Department of Medicine, University of California Irvine Medical Center, Orange, California
    2. Genetic Epidemiology Research Institute, School of Medicine, University of California Irvine, Irvine, California
    3. Deparment of Epidemiology, School of Medicine, University of California Irvine, Irvine, California
    • Chao Family Comprehensive Cancer Center, University of California Irvine Medical Center, 101 The City Drive South, Building 56, Room 241, RT 81, Orange, CA 92868-3298
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    • Fax: (714) 456-2242

  • Jason A. Zell DO, MPH,

    1. Chao Family Comprehensive Cancer Center, Division of Hematology/Oncology, Department of Medicine, University of California Irvine Medical Center, Orange, California
    2. Genetic Epidemiology Research Institute, School of Medicine, University of California Irvine, Irvine, California
    3. Deparment of Epidemiology, School of Medicine, University of California Irvine, Irvine, California
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  • Argyrios Ziogas PhD,

    1. Genetic Epidemiology Research Institute, School of Medicine, University of California Irvine, Irvine, California
    2. Deparment of Epidemiology, School of Medicine, University of California Irvine, Irvine, California
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  • Hoda Anton-Culver PhD

    1. Genetic Epidemiology Research Institute, School of Medicine, University of California Irvine, Irvine, California
    2. Deparment of Epidemiology, School of Medicine, University of California Irvine, Irvine, California
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  • Disclaimer: The collection of cancer incidence data used in this study was supported by the California Department of Public Health as part of the statewide cancer reporting program mandated by California Health and Safety Code Section 103885; the National Cancer Institute's Surveillance, Epidemiology and End Results Program under contract N01-PC-35136 awarded to the Northern California Cancer Center, contract N01-PC-35139 awarded to the University of Southern California, and contract N01-PC-54404 awarded to the Public Health Institute; and the Centers for Disease Control and Prevention's National Program of Cancer Registries, under agreement 1U58DP00807-01 awarded to the Public Health Institute. The ideas and opinions expressed herein are those of the author(s), and endorsement by the State of California, Department of Public Health the National Cancer Institute, and the Centers for Disease Control and Prevention or their contractors and subcontractors is not intended nor should be inferred

Abstract

BACKGROUND.

Racial minorities exhibit poor survival with nonsmall cell lung cancer (NSCLC) that generally is attributed to low socioeconomic status (SES). In this study, the authors investigated the role of SES in this survival disparity among patients with stage I NSCLC.

METHODS.

A case-only analysis was performed on California Cancer Registry (CCR) data (1989–2003). Univariate survival analyses were performed using the Kaplan-Meier method. Multivariate survival analyses were performed using Cox proportional hazards ratios.

RESULTS.

In total, 19,702 incident cases of stage I NSCLC were analyzed. Low SES was identified more commonly in African-American and Hispanic patients and was associated significantly with men, unmarried status, stage IB disease, squamous cell histology, poorly differentiated tumors, fewer surgical resections performed, and less overall treatment received. Reasons for no surgery were associated strongly with low SES and unmarried status but not with race. In multivariate analysis, each incremental improvement in SES quintile was associated with statistically significant decreases in the hazard ratios (HRs) for death (second SES quintile [SES2] vs SES1: HR, 0.91; 95% confidence interval [95% CI], 0.85–0.98; SES3 vs SES1: HR, 0.90; 95% CI, 0.84–0.97; SES4 vs SES1: HR, 0.83; 95% CI, 0.77–0.89; SES5 vs SES1: HR, 0.78; 95% CI, 0.72–0.84; Ptrend < .0001). African-American or Hispanic race was not an independent poor prognostic factor for survival after adjustment for surgery, SES, and marital status.

CONCLUSIONS.

Low SES was an independent poor prognostic factor for survival in patients with stage I NSCLC and was independent of surgery, race, and marital status. Cancer 2008. © 2008 American Cancer Society.

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